Prematür adrenarş olgularının özellikleri ve metabolik sendrom geliştirme risklerinin retrospektif analizi
Evaluation of children with premature adrenarche and retrospective analysis of metabolic syndrome
- Tez No: 342094
- Danışmanlar: PROF. DR. ECE BÖBER
- Tez Türü: Tıpta Uzmanlık
- Konular: Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases
- Anahtar Kelimeler: Premature adrenarche, insulin resistance, polycystic ovary, metabolic syndrome
- Yıl: 2013
- Dil: Türkçe
- Üniversite: Dokuz Eylül Üniversitesi
- Enstitü: Tıp Fakültesi
- Ana Bilim Dalı: Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 83
Özet
Amaç: Prematür pubarş; kızlarda sekiz yaş, erkeklerde dokuz yaşından önce seksüel kıllanmanın başlaması olarak tanımlanır. Çalışmamızın amacı; Prematür adrenarş tanısı alan hastaların başvurudaki antropometrik ölçümlerinin, hormonal parametrelerinin incelenmesi, ayırıcı tanı ile geç başlangıçlı konjenital adrenal hiperplazi tanısı alan olguların tespiti, postpubertal dönemde hipertansiyon, obezite, insülin direnci, hiperlipidemi ve adet düzensizliği, hirsutizm, polikistik over sendromu açısından irdelenmesi. Hastalar ve Yöntem: Dokuz Eylül Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Ana Bilim Dalı, Pediatrik Endokrinoloji Bilim Dalı polikliniğine 2012 yılının sonuna kadar izole pubik ve aksiller kıllanma ile başvurmuş
Özet (Çeviri)
Aim: Premature adrenarche is defined as the appearance of pubic and/ or axillary hair, before eight years in girls, and nine years in boys, in the absence of thelarche or testicular development. In this study, we aimed to evaluate the anthropometric measures, hormonal values of children with premature adrenarche on time of diagnosis, identifying the patients considered to have late onset congenital adrenal hyperplasia, in the postpubertal period analyzing for components of metabolic syndrome; hypertension, obesity, insulin resistance, hyperlipidemia, menstrual irregularity, hirsutism, polycystic ovary syndrome. Patients and method: The study included all patients seen for premature adrenarche, isolated axillary or pubic hair before eight years of age for girls, and nine years for boys, in the pediatric endocrinology unit of Dokuz Eylül University, until the end of year 2012. Study group designed with 94 girls, 14 boys, followed with the diagnosis of premature adrenarche. Retrospective data (gender, age at onset of complaints, height, weight SDS, Tanner staging, weight of birth, family history, lipid parameters, liver function tests, glucose, insulin, DHEAS, AS, 17-OH progesteron levels) of patients was recorded from the department database. At least 5 years after diagnosis patients were invited to hospital for reevaluation. Prospective group included 41 girls and five boys at least 14 year-old. Routine physical examination, height, weight, blood pressure, waist circumference, after providing a 12-hour fasting, serum lipid levels, fasting serum glucose and insulin levels were measured. In obese group, liver function test and abdominal ultrasonography was planned. In patients with hirsutism, menstrual irregularity; DHEAS, total testosterone, 17-OH progesterone, androstenedione, FSL, LH, E2 levels measured. Pelvic ultrasonography was performed for conforming polycystic ovary syndrome. Results: Retrospective analysis; Our study detected a frequency of %8,3, with a history of SGA birth. No significant difference of the parameters of insulin resistance and bone age advancement between the groups of idiopathic, typical and exaggerated premature adrenarche groups, classified according to basal DHEAS levels. %64,3 of patients were detected as BMI ? 1SDS, and in this group there is as statistically significant relationship between fasting serum glucose, no significant relationship was found between the parameters of fasting insulin, insulin resistance and lipid parameters. Between the normal weight and overweight/obese group, no significant difference in adrenal androgen levels was detected. In the overweight and obese group bone age and height SDS were found to be significantly increased. Incidence of insulin resistance was significantly elevated in patients with dyslipidemia. Eleven patients (%10) were diagnosed as non-classical congenital adrenal hyperplasia with the ACTH stimulating test. Prospective analysis: Whereas significant relationship between obesity, PCOS and history of SGA birth, no significant relationship with insulin resistance was found. Being in the exaggerated adrenarche group was statistically significant risk factor for polycystic ovary syndrome. Between the groups; diagnosed with PCOS or not, there was no significant difference in systolic and diastolic hypertension, and dyslipidemia, being overweight or obese, and there was significantly risk was found in the prevalence of insulin resistance in the group with PCOS. Frequency of insulin resistance was significantly elevated in overweight and obese group. In the group with insulin resistance; frequency of hyperandrogenism, polycystic ovary syndrome, hypertension, dyslipidemia was significantly elevated. Postpubertal outcome in the exaggerated adrenarche group; the risk of insulin resistance, obesity, systolic hypertension, hypertrigliseridemia, significantly elevated. Higher DHEAS levels increase the risk of metabolic syndrome in the postpubertal period. Conclusion: Premature adrenarche is a benign condition, but the long term follow up leads to obesity, insulin resistance, hypertension, dyslipidemia, such as one or more of the components of the metabolic syndrome; PCOS, hirsutism, menstrual irregularity, susceptibility to systemic androgenic effects. In this study we showed that in the long term follow up premature adrenarche can lead to one or more component of metabolic syndrome.
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